Robin Nunn has argued that we should stop using the terms ‘placebo’ and ‘placebo effect’. I argue in support of Nunn’s position by considering the logic of why we perform placebo comparisons. Like all comparisons, placebo comparison is just a case of comparing one thing with another, but it is a mistake, I argue, to think of placebo comparison as a case where something is compared to ‘a placebo’. Rather, placebo comparison should be understood as a situation which sets-up the (...) treatment and control groups in a particular way; not as a case involving objects or procedures called ‘placebos’ employed in order to control for ‘placebo effects’. (shrink)

Because no single person or group holds knowledge about all aspects of research, mechanisms are needed to support knowledge exchange and engagement. Expertise in the research setting necessarily includes scientific and methodological expertise, but also expertise gained through the experience of participating in research and/or being a recipient of research outcomes. Engagement is, by its nature, reciprocal and relational: the process of engaging research participants, patients, citizens and others brings them closer to the research but also brings the research closer (...) to them. When translating research into practice, engaging the public and other stakeholders is explicitly intended to make the outcomes of translation relevant to its constituency of users. In practice, engagement faces numerous challenges and is often time-consuming, expensive and ‘thorny’ work. We explore the epistemic and ontological considerations and implications of four common critiques of engagement methodologies that contest: representativeness, communication and articulation, impacts and outcome, and democracy. The ECOUTER methodology addresses problems of representation and epistemic foundationalism using a methodology that asks, “How could it be otherwise?” ECOUTER affords the possibility of engagement where spatial and temporal constraints are present, relying on saturation as a method of ‘keeping open’ the possible considerations that might emerge and including reflexive use of qualitative analytic methods. This paper describes the ECOUTER process, focusing on one worked example and detailing lessons learned from four other pilots. ECOUTER uses mind-mapping techniques to ‘open up’ engagement, iteratively and organically. ECOUTER aims to balance the breadth, accessibility and user-determination of the scope of engagement. An ECOUTER exercise comprises four stages: engagement and knowledge exchange; analysis of mindmap contributions; development of a conceptual schema ; and feedback, refinement and development of recommendations. ECOUTER refuses fixed truths but also refuses a fixed nature. Its promise lies in its flexibility, adaptability and openness. ECOUTER will be formed and re-formed by the needs and creativity of those who use it. (shrink)

Acommon theme in placebo studies is that the terms placebo and "placebo effects" are confusing, misleading, and sloppy, and that there are no agreed definitions. Indeed, many authors treat the conceptual difficulties raised by placebos as a call to action and propose new definitions and reconceptualizations, or even propose abandoning the term altogether. The promise of these approaches is that a new language and new metaphors for thinking about placebo phenomena may deliver clinical, ethical, and methodological advances. However, the nature (...) and impact of these promised advances is rarely... (shrink)

The function of a placebo control in a randomised trial is to permit blinding and reduce risk of bias. Adopting Grűnbaum’s definitional scheme of a placebo, all treatments must be viewed as packages consisting of characteristic and incidental features. An adequate placebo for an experimental treatment contains none of the characteristic features, all of the incidental features, and nothing more. For drug treatments, characteristic features can be readily identified, isolated, and separated. By contrast, physical therapy treatments often involve features such (...) as patient-therapist contact and sensory feedback that make this separation difficult both conceptually and practically. It is therefore unsurprising that attempts to construct placebos for physical therapy treatments have in the past led to biased estimates of treatment effects. In this perspective piece, we describe the problem with constructing placebos for physical therapy trials drawing upon Grűnbaum’s definition and using paradigmatic examples from existing literature. We conclude by submitting that in the many cases where an adequate placebo cannot be achieved, alternative trial designs, e.g. dose-response or comparative-effectiveness trials, carry a lower risk of bias and should be favoured. (shrink)

Reimer ( Neuroethics 2008 ) believes that how we use language to characterize psychopathy may affect our judgments of moral responsibility. If we say a psychopath has a disorder we may reduce their responsibility for moral failure. If we say a psychopath is merely different, we may not reduce their responsibility. Vincent ( Neuroethics 2008 ) argues that if this were the case, a diagnosis of disorder would be both necessary and sufficient to reduce the responsibility of some agent for (...) moral failure. Vincent presents two examples to suggest that a disorder is neither necessary nor sufficient to exculpate an individual for moral failure: childhood and hypomania. Vincent suggests instead that our judgments of moral responsibility ought to be based on the individual’s capacity for moral agency. I will side with Vincent in this debate, but argue that the example she uses, hypomania, does not work. I will argue that a diagnosis of hypomania, part of Bipolar II Disorder, is sufficient to exculpate an individual for some moral failure. This is because there are responsibility-relevant capacities missing: the capacities for self-awareness and to control ones abilities. Without these capacities, the individual is not a responsible moral agent. Vincent will need to provide an alternative example to show that the presence of a disorder is not sufficient to exculpate an individual for moral failure. Whilst our use of language is important, that use reflects our judgments of the individual’s capacities for moral agency. Responsibilities are determined not only by capacities, but by the right kind of capacities, and this should be reflected in our moral judgments, and our use of language. (shrink)

Medicine today, as both art and science, embodies a split personality. The ensuing tension—between individualized consideration, experience, and judgment on the one hand, and standardization, objective evidence, and guidelines on the other—plays out in the simultaneous aspirations of the medical humanities and evidence-based medicine, and in a host of other telling terms and movements. This is not a new tension, however. We turn in this paper to the critical but complex history of the term “personal equation” as both reflective and (...) generative of this tension on both sides of the Atlantic during a formative period in medicine from the mid-19th through the mid-20th centuries. The term was featured in almost every... (shrink)

In 2009, the UK House of Commons Science and Technology Committee conducted an ‘evidence check’ on homeopathy to evaluate evidence for its effectiveness. In common with the wider literature critical of homeopathy, the STC report seems to endorse many of the strong claims that are made about its implausibility. In contrast with the critical literature, however, the STC report explicitly does not place any weight on implausibility in its evaluation. I use the contrasting positions of the STC and the wider (...) critical literature to examine the ‘implausibility arguments’ against homeopathy and the place of such arguments within evidence-based medicine. I argue that the STC report undervalues its strong claims about the mechanistic plausibility of homeopathy because it relies on a misunderstanding about the role of mechanistic evidence within EBM. This is not a conclusion for a revision of the role mechanistic evidence plays within EBM, however. It is a conclusion about the inconsistency of the STC report’s position towards implausibility arguments, given the evidential claims they endorse and the atypical situation that homeopathy presents. It provides a further example of the general point that mechanistic reasoning should not be seen as providing categorically lower quality evidence. (shrink)

The economic aspects of biobanking are intertwined with the social and scientific aspects. We describe two problems that structure the discussion about the economics of biobanking and which illustrate this intertwining. First, there is a ‘sustainability problem’ about how to maintain biobanks in the long term. Second, and representing a partial response to the first problem, there is a ‘commercialisation problem’ about how to deal with the voluntary altruistic relationship between participants and biobanks, and the potential commercial relationships that a (...) biobank may form. Social scientists have argued that the commercialisation problem is inadequate as a way to construct the multiple tensions that biobanks must negotiate. We agree that the commercialisation problem is an inadequate framework; turning to alternative accounts of bioeconomy, we suggest that contemporary consideration of the economics of biobanking primarily in terms of participants and their bodily tissue may reproduce the very commodification of science that these scholars critique. We suggest that an alternative conception of the economics of biobanking beyond the logics of commodification, which may thereby allow broader questions about the social and economic conditions and consequences of biobanks to be posed. (shrink)

In The Metaphysics Book Theta, Chapter four, Aristotle claims that to state that “some X is possible but X will never be” is a mistake. In effect, he collapses the possible into the actual. This view conflicts with the existence of dispositions which I argue exist, as they are indispensable to science. In Theta Chapter three, Aristotle sets out a test of possibility whereby we assume that some entity exists and then see if an impossibility ensues. I apply this test (...) to Aristotle’s theory and show that it entails the impossibility of dispositions. Given the clear existence of dispositions, Aristotle’s conflation of the possible with the actual fails his own test of possibility and must be wrong. (shrink)

Aristotle argued that particular statements about the future were neither true nor false. Turner rejects this claim, arguing that implicit to such a theory is an untenable theory of time. Whilst developing a theory of time was not Aristotle’s intent, Turner believes his view does entail an ontology that is questionable at best. Once we have sorted out an acceptable theory of time, the only reasonable conclusions about all statements is that they are true or false. That we do not (...) know whether our statements about the future are true or false is an epistemological problem. This claim is aimed at those who wish to adopt Aristotle’s view today. (shrink)

The article reviews several books about philosophical isuuses including "Against Coherence: Truth, Probability, and Justification," by Olsson Erik J., "Fixing Frege," by Burgess John, "Events and Semantic Architecture," by Pietroski Paul M.